The Republican-led states that have opted not to expand Medicaid are trying a variety of strategies to save struggling hospitals and cover more people without full expansion, which was one of the key provisions of the Affordable Care Act.
Georgia passed a partial expansion of Medicaid, the federal-state program that provides health coverage to low-income and disabled Americans, earlier this year. States such as Alabama and Florida have bumped up spending on programs that serve specific populations, such as pregnant women or residents with mental health needs. And Mississippi Republican Gov. Tate Reeves last month floated a plan to use federal money to increase Medicaid reimbursements to hospitals.
But health care advocates say those efforts are weak substitutes for full expansion — especially as non-expansion states continue to fare poorly on most health metrics.
(READ MORE: Tennessee drops over 31,000 from Medicaid in one month as renewals resume)
A decade after the U.S. Supreme Court ruled states’ participation in Medicaid expansion was voluntary, the 10 holdouts (plus North Carolina, which recently approved expansion but hasn’t implemented it yet) account for most of the rural hospital closures over the past decade, according to the American Hospital Association. They tend to have the highest percentages of uninsured adults, the highest infant and maternal mortality rates, and their residents are more likely to suffer from chronic conditions such as heart disease and diabetes.